Healthcare Provider Details

I. General information

NPI: 1770797953
Provider Name (Legal Business Name): LORRAINE ROSAMILIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2188 SANDY DR
STATE COLLEGE PA
16803-2288
US

IV. Provider business mailing address

155 WELLNESS WAY
STATE COLLEGE PA
16803-6702
US

V. Phone/Fax

Practice location:
  • Phone: 814-237-6600
  • Fax: 814-237-5383
Mailing address:
  • Phone: 814-231-7100
  • Fax: 814-238-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD436550
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMT186384
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: